On vaccines, autonomy and the shadows on the cave wall

Plato’s Allegory of the Cave in his “Republic” remains a classic parable of human nature. Here, prisoners in an underground cave mistake shadows on the wall with reality. They confuse the superficial for truth. Their screen altar, fashioned well before our devices, is their universe.

This blunder has played out through time. Study history and you study human nature. Now, during the most devastating public health crisis in over a century, our shadows on the wall are about “individual rights.”

When it comes to mandating COVID-19 vaccinations, particularly for health care workers, valid reasons for exemptions include medical and religious. But what if I object solely because any mandate violates my rights and autonomy? After all, in biomedical ethics, autonomy, or self-determination, has eclipsed the other moral principles of beneficence, nonmaleficence, and justice, even though they are intended to act upon each other as checks and balances.

The appeal to individual rights is likewise the default posture in our culture. We hear it often: “You can’t tell me what to do!” In the process, it has become a moving target, meaning different things in different theories to different persons. For instance, philosophers John Rawls and Robert Nozick hold clashing views of justice. And their arguments rest upon their versions of autonomy.

Joining the autonomy and individual rights bandwagon is easy in a consumer world in which our unbounded right to choose and spend at whim percolates in a mindset of a winner-takes-all narcissism, flagging Self over Others. However, though lionized in both Western biomedicine and society, autonomy has become breathtakingly truncated from its philosophical roots.

Even though notions of self-rule abound in Plato, Epictetus, Augustine, Jean-Jacques Rousseau, John Locke, John Stuart Mill, and numerous others, autonomy proponents, at least in bioethics, often hold that our contemporary version of autonomy stems from Kantian philosophy. Immanuel Kant does indeed affirm autonomy as morality’s centerpiece. But let us look more closely under the hood. In his “Critique of Practical Reason,” he deftly underscores autonomy, but not an autonomy of the individual. Instead, he describes an “autonomy of the will,” differentiating it from “heteronomy of choice.” This autonomy of will consists of a rational will in accord with universal principles. To repeat: universal.

In contrast, a heteronomy of choice occurs when I pursue my own will in line with my own belief and desires, regardless of others and their well-being. Consider a restaurant in Rowlett, Texas, requiring all customers to be unmasked. A couple was recently asked to leave. They were wearing masks to protect their immunocompromised 4-month-old son at home with cystic fibrosis. Kant firmed up his opposition to this heteronomy of choice in a version of his landmark categorical imperative. Namely, acting morally hinges upon what we should do based on universal principles, not on what we feel we should do based on what we desire.

His point is clear. Our choices and actions need to be in harmony with a rule or principle that can reasonably become universal, applied to all. As a health care professional, can my personal objection to vaccination solely on the grounds of defending my autonomy be universalized? Even when it inordinately means unintentionally incurring likely harm to others? This moral imperative demands a certain detachment from my own circle of concern in order to ascertain principles benefitting all. It requires a degree of mature reflection. Without it, like the prisoners, we fail to see shadows on the wall for what they are.

Impartiality’s all-too-crucial role in morality hits home. When it comes to foundational moral principles and values, the final court of appeal is neither you nor me. There is no privileged center. What applies to us all?

Michael Brannigan is a philosopher, author, and speaker. Email: [email protected] Website: www.michaelcbrannigan.com.

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